Provider Demographics
NPI:1285383265
Name:RUDNICKI, CONSTANCE (RD)
Entity type:Individual
Prefix:MS
First Name:CONSTANCE
Middle Name:
Last Name:RUDNICKI
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3900 PASEO DEL SOL
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87507-4072
Mailing Address - Country:US
Mailing Address - Phone:505-310-2384
Mailing Address - Fax:
Practice Address - Street 1:3900 PASEO DEL SOL
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87507-4072
Practice Address - Country:US
Practice Address - Phone:505-310-2384
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-18
Last Update Date:2022-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMLD-0797133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered